- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.76 / $1,371.79 / $2,470.96
| Professional | | $1,079.76 | $1,371.79 | $2,470.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.10 / $1,402.34 / $2,307.46
| Professional | | $1,020.10 | $1,402.34 | $2,307.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,388.58 / $1,503.59 / $1,913.66
| Professional | | $1,388.58 | $1,503.59 | $1,913.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.05 / $1,841.25 / $2,674.06
| Professional | | $1,252.05 | $1,841.25 | $2,674.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.05 / $1,845.32 / $2,726.67
| Professional | | $1,252.05 | $1,845.32 | $2,726.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.74 / $1,001.09 / $1,710.54
| Professional | | $144.74 | $1,001.09 | $1,710.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.45 / $1,877.11 / $2,961.02
| Professional | | $1,224.45 | $1,877.11 | $2,961.02 |